Provider Demographics
NPI:1841264710
Name:FOWLER, SHAUNA L (MPT)
Entity type:Individual
Prefix:MRS
First Name:SHAUNA
Middle Name:L
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W 8TH
Mailing Address - Street 2:# 170
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2312
Mailing Address - Country:US
Mailing Address - Phone:509-838-4700
Mailing Address - Fax:509-838-4716
Practice Address - Street 1:105 W 8TH
Practice Address - Street 2:# 170
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2312
Practice Address - Country:US
Practice Address - Phone:509-838-4700
Practice Address - Fax:509-838-4716
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 00008142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA159195OtherLTI
WA8335051Medicaid
WA8335051Medicaid